Respiratory valve

ABSTRACT

A respiratory valve apparatus with a housing having a upper entry port and an opposite endotracheal tube connection port, along with a resuscitation bag connection port and an respirator connection port. The housing has an inner chamber. A reciprocating valve assembly fits within a chamber and slides between two positions whereby the entry, endotracheal, and respirator ports are open in one position, and the entry, endotracheal, and resuscitation ports are open in the second position. The valve assembly is a component of a surgical kit including a resuscitation bag, an endotracheal tube, and a suction catheter. A guide fixture can be attached to the entry port to help steer a catheter through the apparatus. An elongated protective bag can be sealably attached around the catheter to prevent external contact with the catheter surfaces when it is withdrawn.

FIELD OF INVENTION

[0001] This invention relates to respiratory valves apparatus used inendotracheal medical procedures involving a respirator, a resuscitationbag, and a suction catheter. In particular, the present invention is arespiratory valve apparatus that facilitates rapid switching between arespirator, or breathing machine, and a resuscitation bag whilemaintaining ventilation functions and without losing positive endexpiratory pressure (PEEP), the respiratory valve apparatus permittingthe withdrawal and insertion of a catheter from a sanitaryself-contained enclosure for endotracheal suctioning.

BACKGROUND OF THE INVENTION

[0002] Respiratory support systems are commonly used to support therespiratory system of a critically ill patient for maintaining optimalblood oxygen levels, as well as optimal carbon dioxide levels and acidbase balance. Typically, a prior art respiratory support system includesa tracheal tube, positioned either directly through the nose or mouthinto the trachea of a patient. A multi-ported manifold is connected tothe endotracheal tube at one port position, and a source of breathablegas is connected at a second port. The respiratory support systemassists the patient in maintaining adequate blood oxygenation levelswithout overtaxing the patient's heart and lungs.

[0003] While a patient is attached to the respiratory support system, itis periodically necessary to aspirate fluids and or secretions from thepatient's trachea and lungs. In the past, in order to accomplishaspiration and positive pressure ventilation, it was necessary todisassemble part of the respiratory support system, either by removingthe ventilator manifold or by opening a port thereof and inserting asmall diameter suction tube down the tracheal tube and into thepatient's trachea and lungs. The fluid was then suctioned from thepatient and the suction catheter was removed and the respiratory supportsystem reassembled. However, due to the interruption of respiratorysupport during this procedure, a patient's blood oxygen can often dropand the carbon dioxide can change to unacceptable levels. Additionally,unless a sufficient positive end expiratory pressure (PEEP) level ismaintained, then the lungs might collapse. This creates a dangerouscondition for the patient because the lungs can be difficult, andsometimes impossible, to reinflate.

[0004] Patients may have fluid drawn from their lungs as often as sixtimes a day and sometimes more, possibly over long periods of time. Forthis reason, it is critical to provide a respiratory device which willminimize patient discomfort. In addition, such a device could be widelyused in treating pediatric patients, especially premature infants, aswell as adults, who are subject to respiratory problems and may needfrequent aspirations. As a result of the extremely large number ofaspirations necessary on various patients in any period, it is importantthat the price of the respiratory device be as low as possible sincevast numbers will be used. It is also important that the device besufficiently inexpensive so that it may be discarded after a single use.Hence, it is desirable to simplify such devices and reduce the number ofparts in order to reduce costs and increase reliability.

[0005] U.S. Pat. No. 5,746,199 to Bayron et al teaches a rotary valvewith multiple ports, any two of which can be aligned with openings inthe casing to provide through passages for delivering breathable gasesto an endotracheal tube. The valve has a handle that cooperates withdetents on the casing to secure the position of the rotary valve.However, any catheter inserted and removed through the endotracheal tubeand valve ports that are connected with the ventilation ports provides acontact pathway for infectious organisms to the ventilators.

[0006] The manufacture of this rotary valve, as well as the other rotaryvalves mentioned here, requires precise control of the circulartolerances of the rotary valve and casing to prevent leakage around thevalve. Such safety concerns increase the costs of manufacture andquality control measures.

[0007] Other prior art devices have attempted to maintain a continuousflow of oxygen from the respirator device through to the lungs, whileallowing for insertion and retraction of the suction catheter. However,such devices fail to provide an operable system capable of performingboth manual and machine assisted respiration without disconnecting therespirator. Manual respiration with a resuscitation bag during suctionis a preferred method among many practitioners because it optimizesremoval of fluids in the lungs while maintaining PEEP and maintainingcardiopulmonary and hemodynamic balance. U.S. Pat. No. 4,351,328discloses a device for simultaneous respiration and endotrachealsuctioning of a critically ill patient. This device requires aspecialized sealing port for insertion and retraction of the suctioncatheter to maintain the integrity of the respiration system. Whilemachine assisted respiration is occurring, no switchover to manualresuscitation methods is provided.

[0008] U.S. Pat. No. 5,343,857 discloses an accessory port capable ofreceiving a specially designed male adaptor on a suction catheter. Theaccessory port consists of a normally closed valve which is forced openby the male adaptor, and returns to its closed position upon retractionof the adaptor. The adaptor sealably interacts with the accessory portso as to inhibit pressure loss from the manifold. A similar device isdisclosed in U.S. Pat. No. 5,309,902.

[0009] As detailed in the background discussions of these prior artdisclosures, there are many difficulties associated with maintainingcontinuous pressure from the respiration supply device. Moreparticularly, it is often desirable to be able to manually inflate thelungs with a resuscitation bag at different rates and different volumesin order to facilitate complete aspiration of mucous and liquid from thelungs. With the extra “hands-on” control offered by the resuscitationbag, a doctor or technician can simulate expectory coughing actions andthe like through quick inflation and deflation bursts. Moreover, PEEPcan be easily maintained with the resuscitation bag, while the suctioncatheter is repeatedly inserted and retracted from the lungs as needed.

[0010] Other interface devices require the respirator source to bedisconnected in order to attach the desired resuscitation bag. Onceaspiration is complete, this presents a problem with maintaining PEEPwhen the resuscitation bag is disconnected and the respirator source isreconnected. Even if performed in a timely and efficient manner, thisswitchover operation can jeopardize the patient's life if PEEP is notmaintained. Hence, it is important to minimize this switchover time,while also providing for attachment of the resuscitation bag. Otherdevices remain connected to the respirator source and do not allow foruse of a resuscitation bag.

[0011] U.S. Pat. No. 5,207,641 discloses a switching device with arotary valve having aspiration, insufflation, and intermediate flushingpositions. An oxygen port and suction port are included with a catheterport. These ports allow suction and insufflation to alternately occurthrough the continuously inserted catheter, without withdrawal of thecatheter tube from the lungs. While providing a neutral valve position,this arrangement might still encounter problems such as blow-back ofmucous through the inserted catheter, and/or clogging of the valve partsby suctioned mucous.

[0012] U.S. Pat. No. 3,780,736 discloses a surgical valve assembly forurinary bladder irrigation and drainage. This valve has four ports andprovides a core for interconnecting any two of the four ports. The coreallows irrigation fluids to flow from one port to another, but the '736device does not disclose a valve for introduction and withdrawal of asuction catheter through the device in either of two switched positions,and the '736 device does not disclose ports for receiving air from arespirator in one switched position or alternatively from aresuscitation bag in the other switched position.

[0013] Given the frequent insertion and withdrawal of the suctioncatheter, a protective bag, or sleeve, would also be a useful additionto existing suction catheter devices. This bag would prevent externalcontact with the catheter thereby maintaining a sterile device forreinsertion into the patient. U.S. Pat. No. 5,073,164 discloses aspecialized catheter which incorporates a protective sleeve. A bag whichcan be sealably attached around any existing suction catheter would beeven more versatile than the incorporated sleeve.

[0014] Accordingly, what is lacking in the art is a compact,inexpensive, improved, simplified respiratory device which canaccommodate the introduction of a catheter into a patient's lungsseparated from the respiratory valve while maintaining connection withan external respirator source, and which will subsequently allowuninterrupted respiratory switchover to a resuscitation bag to maintainoptimal ventilation.

SUMMARY OF THE INVENTION

[0015] The present invention provides a respiratory valve apparatus withan elongated housing having an a ventilating valve structure separatedfrom an aspiration port. The ventilating valve switches between a manualresuscitation bag port and a ventilator port. A patient can therebyreceive continuous support from a respirator or an attachedresuscitation bag, depending upon the position of the valve. Byproviding an efficient switchover between the respirator andresuscitation bag, a patient can be treated in such a manner withouthaving to disconnect the respirator support system to thereby connectthe resuscitation bag. This prevents the loss of positive end expiratorypressure (PEEP) in the lungs and guards against lung collapse andhemodynamic compromise. The apparatus provides a separate port with asealing orifice for insertion and retraction of a catheter into theendotracheal tube to prevent contact contamination of the valve.

[0016] Additional features include a hingably attached cover for theresuscitation bag port when a resuscitation bag is not attached. Ahingably covered or sealable port for a catheter suitable for injectionof saline or aspiration.

[0017] It is therefore an object of the present invention to provide arespiratory valve apparatus which can switch between an attachedexternal respirator support system and an attached resuscitation bag,and can accommodate insertion of a suction catheter through theapparatus when placed in either switched position.

[0018] It is a related object of the present invention to provide arespiratory valve apparatus having a housing with a suction catheterentry port, a endotracheal tube connection port, a respirator connectionport, and a resuscitation bag connection port.

[0019] It is still another object of the present invention to provide aninner reciprocating valve assembly contained within the apparatus whichcloses the respirator port and opens the resuscitation bag port in oneposition and opens the respirator port and closes the resuscitation bagport in another position.

[0020] It is yet another object of the present invention to provide aseparate sealable entry port in the apparatus which seals uponwithdrawal of the catheter.

[0021] It is a further object of the present invention to provide aspring bias in the reciprocating valve.

[0022] It is another object of the present invention to provide auniversal adapter to connect to different conventional resuscitationbags.

[0023] It is still another object of the present invention to provide ahingably attached cover for the resuscitation bag port for sealablycovering the port when a bag is not attached.

[0024] It is yet another object of the present invention to provide ahingably covered or sealable saline port in the housing assembly forinjecting saline to clean the valve assembly parts.

[0025] Other objects and advantages of this invention will becomeapparent from the following description taken in conjunction with theaccompanying drawings wherein are set forth, by way of illustration andexample, certain embodiments of this invention. The drawings constitutea part of this specification and include exemplary embodiments of thepresent invention and illustrate various objects and features thereof.

BRIEF DESCRIPTION OF THE DRAWINGS

[0026]FIG. 1 shows a partial cross section of one embodiment of therespiratory valve assembly of this invention with the respirator portclosed and the resuscitation bag port open;

[0027]FIG. 1A shows a partial perspective view of the respiratory valveassembly of FIG. 1 with the respirator port open;

[0028]FIG. 2 shows an a partial cross section as in FIG. 1 with therespirator port closed;

[0029]FIG. 2A shows a plan view of a guide shown in FIG. 2;

[0030]FIG. 2B shows a perspective of the cylinder valve shown in FIG. 2;

[0031]FIG. 3 shows a perspective of another embodiment of therespiratory valve assembly of this invention with a resuscitation bag;

[0032]FIG. 4 shows a top plan view of the respiratory valve assembly ofFIG. 3, partially in section;

[0033]FIG. 5 shows a side view of the valve assembly of FIG. 4,partially in section;

[0034]FIG. 6 shows a perspective of another embodiment of therespiratory valve assembly of this invention;

[0035]FIG. 7 shows a cross section of the valve assembly of FIG. 6 withthe respirator port closed; and

[0036]FIG. 8 shows a cross section of FIG. 6 with the respirator portopen.

DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENT

[0037] Although the invention is described in terms of a severalembodiments, it will be readily apparent to those skilled in this artthat other various modifications, rearrangements and substitutions canbe made without departing from the spirit of the invention. The scope ofthe invention is defined by the claims appended hereto.

[0038] Referring now to FIGS. 1 and 2, the assembly has a housing 12 andan inner chamber 14. The housing 12 includes an upper access port whichis a suction catheter entry port 16 located on the top and aendotracheal tube connection port 18 located on the bottom. The entryport 16 has a flexible orifice 24 covering the top and may include asaline injection port 20, shown in FIG. 3, which can be covered by ahingably attached plug 22. Port 20 might alternatively use a sealableorifice. The sealable orifice may be closed with a cap of resilientmaterial having diametrical cuts forming openable flaps. Alternatively,the aspiration port 16 may be used for administering a saline solution.An endotracheal tube 26 can be removably attached to the endotrachealconnection port 18.

[0039] In the embodiment shown in FIGS. 1-2, the housing 12 is anelongated L-shaped tubular structure with the respirator port 32 at oneend and the endotracheal connection port 18 at the other end. Theresuscitation bag port 28 extends from the shaft of the L-shapedhousing.

[0040] The valve 11 is a hollow cylinder 35 with an open top 36, aclosed bottom, and an opening 37 in the side wall. The opening 37 isaligned with the endotracheal tube port 18 so that air from theresuscitation bag flows through the resuscitation bag port, through thecylinder and into the endotracheal tube port while the remainder of thecylinder wall blocks the respirator port. The reciprocating valve 11slides partially within the resuscitation bag port 28 and the innerchamber 14 intermediate the ends of the L-shaped housing. Thereciprocating valve 11 and the resuscitation bag port are normal to therespirator valve port 32. The valve 11 is moved by the universalresuscitation bag adapter 113 in the port 28. As the valve moves, itopens the resuscitation bag port 28 and closes the respirator port 32.The valve 11 has a valve stem 112 that telescopes through a valve spacer114. The universal resuscitation bag adapter 113 serves to connectdifferent resuscitation bags to the respiratory bag. In the event therespiratory valve is supplied as part of a kit, including aresuscitation bag, the adapter may not be present.

[0041] The spacer 114 has an outer ring with the circumference fixed tothe resuscitation bag port wall. The spacer 114 is a stop for the spring124. The ring may have spokes 115 and a hub 116, as shown in FIG. 2A.The hub 116 is of such diameter to permit the sliding movement of thevalve stem 112 therethrough. The movement of the valve stem 112 throughhub 116 and the circumferential sliding contact between valve 11 and theresuscitation bag port acts as a valve guide.

[0042] The valve 11 has a circular solid valve bottom face 117 of adiameter to close the valve seat 125 at the inner end of theresuscitation bag port 28, as shown in FIG. 1. The circular face 117also forms one end of the cylindrical sleeve 35. The length and diameterof the sleeve 35 is such to close the respiratory port, as shown in FIG.2. As shown in FIGS. 1 and 1A, the solid plate and the sleeve arestopped and sealed by the circular valve seat 120. As shown in FIG. 2B,the upper edge of the sleeve 35 is formed with a ring 121 which slidesalong the inside of the resuscitation bag port to further stabilize thereciprocation of the valve 11. The ring supports the end of the valvestem with chord bars 122. The ring 121 may also be similar in form tothe valve spacer 114. The upper end of the valve stem 112 has a retainer123. The retainer 123 may be in the form of a cross bar, as shown, or aperforated ring to allow air passage.

[0043] The resuscitation bag adapter will engage the retainer 123, suchas shown in FIG. 1. A coil spring 124 is mounted about the valve stemand held in place by the retainer 123. The other end of the coil springrests on the valve spacer 114. In this manner, the spring is compressedas the resuscitation bag adapter 113 moves the valve to close theventilator port. The retainer 123 slidably contacts the inside of theresuscitation bag port. The inner wall of the resuscitation bag portalso has two opposing longitudinal grooves 126. The ends of the retainer123 slide in the grooves 126 in response to pressure from the adapter113. The grooves maintain alignment of the opening 37 in the valvecylinder with the endotracheal tube port 18. The enlarged portion may ormay not be present in order to accommodate the conventionalresuscitation bag fittings.

[0044] As shown in FIG. 1, the tubular adapter 113 has opposite bayonetslots 33 in the side wall. The slots cooperate with opposing lugs 34 onthe resuscitation bag port wall to guide movement of the adapter andlock the port open while the bag is being used.

[0045] Therefore, as shown in FIG. 1, with the respirator valve port 32closed, the patient can receive manual resuscitation bag breathingaugmentation through the inner chamber of the valve assembly. Aresuscitation bag, as shown in FIG. 3, may be connected to the universalresuscitation bag adapter and the valve assembly will automatically movethe valve to close the respirator port and open the resuscitation bagport, as shown in FIG. 1A. When the bag is disconnected, the adapter isrotated to unlock the bayonet fitting and the valve assemblyautomatically re-establishes the airway between the respirator and thepatient.

[0046] A connection to the patient is located at the bottom of theL-shaped valve assembly, usually by an endotracheal tube attached to thevalve assembly. As shown in FIGS. 1 and 2, the aspirator port 16 is inline with the endotracheal port 18. This suction tube port is normallyclosed either by a removable cap or a resealing entry 24. The suctiontube is linearly displaced from the reciprocating valve, theresuscitation bag and the respirator to avoid direct contact with anycontamination in the suction tube.

[0047] In the embodiment shown in FIGS. 3-5, a cruciform valve assemblyhas a resuscitation bag attachment port 28 extending out one side,oriented approximately 90 degrees from the entry port 16 andendotracheal tube connection port 18. This port 28 can be sealablycovered by a hingably attached cover 30. On the opposite side of the bagattachment port 28 is a respirator attachment port 32 for attaching anexternal respirator device.

[0048] In this embodiment, the linear displacement of the suction tubefrom the valve is accomplished by a bifurcated valve stem 212. As shown,a valve spring 224 is coiled about each element of the split stem withone end contacting a retainer 223 on each split. Alternatively, a singlecoil spring could encircle the bifurcated valve stem. The retainer maybe a cross bar, as shown in FIG. 1 or a perforated disk. The other endof the coil spring contacts the back side of the resuscitation bag portvalve spacer 214.

[0049] The spacer 214 is fixed about its circumference in theresuscitation bag port 28. The spacer 214 is perforated, as is spacer114, but has two apertures for sliding engagement with the bifurcatedvalve stem 212. Each spring 224 rests on the spacer 214 and iscompressed by the valve retainer 223 as the valve reciprocates towardthe respirator port.

[0050] The valve 211 is a solid disk and has a diameter very close tothe diameter of the resuscitation bag port and the respirator port toform an edge seal with each port when seated therein. Alternatively,each port may have an internal valve seat to contact the opposite facesof the circular valve, as shown in FIGS. 4 and 5. These valve seats alsoserve as stops for the reciprocating movement of the valve. One face ofthe valve closes the resuscitation bag port 28 at seat 225 and the otherface 218 of the valve face seats in the respirator port 32 at valve seat217.

[0051] In this manner, the valve stem is housed in the resuscitation bagport while that port is closed. A suction tube may be inserted directlythrough the aspiration port into the endtracheal connection port withoutcontacting either valve, as shown in FIGS. 9-10. With the respiratorport closed by the valve, an aspirator tube may pass between theelements of the split valve stem 212. To provide better reciprocatorysupport, each element of the split valve stem may be formed with asemicircular outer surface with the same diameter as the valve 218.

[0052] The embodiment shown in FIGS. 6-8 provides a smaller profile forthe valve assembly. This smaller embodiment would be extremely usefulwhen working with infants and children. In this embodiment, theoperation and structure of valve 11 is the same as the L-shaped valveassembly of FIGS. 1-2. The angular relations between the ports have beenmodified to reduce the overall size of the device. The suction catheterentry port 16 enters the housing 12 downstream from the resuscitationbag port and valve 11 to provide the linear displacement between thesuction catheter and the valve. In all other respects, the valveassembly and operation are the same.

[0053] In each of the embodiments, the inner chamber 14 provides aconduit between the entry port 16 and endotracheal tube connection port18 whereby a suction catheter can be inserted through the valve assembly10. A resuscitation bag, not shown, can be attached to the resuscitationbag port 28. With the endotracheal tube 26 attached to the connectionport 18, the respiratory valve assembly 10 could be positioned over apatient's mouth with the endotracheal tube extending into the patient. Acatheter could be inserted through the inner chamber and theresuscitation bag could be used to manually provide volumetric units ofair into the patient's lungs. By skillfully combining the manualinflation actions with the suction catheter procedure, optimum clearingof the lungs can be accomplished. At which time the suction catheter maybe removed from the assembly.

[0054] When the bag is removed from the respiratory valve, thereciprocating valve 11 closes resuscitation bag port and opens therespirator attachment port 32 so that the respirator connection will nowbe breathably connected to the patient without loss of PEEP in thepatient's lungs. The suction catheter can then be reinserted andwithdrawn as needed through the assembly 10.

[0055]FIG. 6 illustrates a valve seat 120 matching the circumference ofthe internal valve 11 extending through the respirator port. As analternative, the interior wall of the respirator port may be molded toform a seat for the bottom of the valve 11, as shown in FIGS. 7-8. Thissame structure may be used in the respiratory valve shown in FIGS. 1-2.

[0056] Referring now to FIG. 9, a perspective view of the respiratoryvalve assembly 10 is shown with an exploded view of the additionalbag-like attachment 60 and an attachment fixture 62. The attachmentfixture 62 is tubular in shape and removably attaches, via snugfrictional contact or otherwise, with the catheter entry port 16. Whilethe preferred embodiment would likely be constructed of opaque plastic,a transparent version of the attachment fixture 62 shows an innerconical guide 64 which steers an inserted catheter down through thecenter portion of the orifice 24. This eases catheter insertion throughthe orifice 24 because the center part of the orifice is more flexibleand less resistant than the edges. The bag-like attachment 60 isthreaded over the suction catheter 66 and the bottom end 67 of the bagis secured around the fixture 62 with a strip of seal forming adhesivetape 68, or other such materials. The upper end 61 of the bag 60 issecured around the upper attachment fixture 70 by another strip of sealforming adhesive tape 72. Also shown is a saline adaptor port 63 forflushing out the system which extends outwards for convenient access andhas a hingably attached cover 65. In lieu of, or in addition to, thehingably attached cover 65, the port 63 might include a bendable, orhingable flap 75 within the extension tube which would allow forinjection of saline in one direction, and which would spring back intoposition to prevent further escape of gas and/or fluids when the salineinjection device is withdrawn.

[0057] Referring now to FIG. 10, a perspective view of the assembleddevice 74 is shown. The guide fixture 62 fits over the entry port 16 soas not to block the saline injection port 20. The adhesive tape strip 68wraps around and secures the bottom bag end 67 to the fixture 62. Theconical guide section 64 is then placed over the center of the orifice24. The upper end 61 of the bag 60 is sealably constricted around theupper attachment fixture 70 via the adhesive tape strip 72. This guidefixture 62 shows an alternative saline port 69 which is located flush onthe side of the fixture 62 and which uses a sealable orifice 71. Anysaline port configuration can be used as appropriate.

[0058] The respiratory valve assembly, a resuscitation bag, anendotracheal tube, and a suction tube may be supplied as a surgical trayor kit. This organization presents the physician and nurses with all theequipment to perform a complete procedure. All of the components aresized to securely fit together and are located in the same kit.

[0059] It is to be understood that while certain forms of the inventionare illustrated, it is not to be limited to the specific forms orarrangements of parts herein described and shown. It will be apparent tothose skilled in the art that various changes may be made withoutdeparting from the scope of the invention and the invention is not to beconsidered limited to what is shown in the drawings and descriptions.

What is claimed is:
 1. A respiratory valve apparatus comprising: ahousing having an inner chamber connected to an access port, anendotracheal tube connection port, a respirator connection port and aresuscitation bag connection port; said respirator connection port andsaid resuscitation bag port each having a valve seat inside said innerchamber; a reciprocating valve assembly which slidably fits inside saidinner chamber, said assembly having a valve connected to a valve stem,said assembly closing said resuscitation bag connection port with saidvalve engaging said valve seat in said resuscitation bag port andopening said respirator connection port in a first position; saidassembly adapted to reciprocate to open said resuscitation bagconnection port and close said respirator connection port with saidvalve engaging said valve seat in said respirator connection port in asecond position; a channel being aligned with said access port and saidendotracheal tube connection port; wherein a suction catheter can beinserted through said channel in said first and second valve assemblypositions.
 2. The respiratory valve apparatus of claim 1, wherein saidvalve assembly includes a spring means biasing said assembly to saidfirst position.
 3. The respiratory valve apparatus of claim 1, whereinsaid valve stem includes a retainer, a valve spacer fixed in saidresuscitation bag port, said means for biasing including a coil spring,one end of said coil spring contacting said retainer, the other end ofsaid coil spring contacting said valve spacer whereby said spring iscompressed as said valve moves from said resuscitation bag port towardsaid respirator port.
 4. The respiratory valve apparatus of claim 1,wherein said access port includes a sealable orifice adapted for entryof said suction catheter and which seals upon retraction of saidcatheter.
 5. The respiratory valve apparatus of claim 1, wherein saidresuscitation bag connection port includes a hingably attached portcover.
 6. The respiratory valve apparatus of claim 1, wherein saidhousing assembly includes a saline injection port with a sealableorifice.
 7. The respiratory valve apparatus of claim 6, wherein saidhousing includes a saline injection port with a hingably attached portplug.
 8. The respiratory valve apparatus of claim 1, which furtherincludes a kit having a resuscitation bag adapted to securely connectwith said resuscitation bag connection port, an endotracheal tubeadapted to securely connect with said endotracheal connection port and asuction tube adapted to pass through said access port into saidendotracheal tube.
 9. The respiratory valve apparatus of claim 8, whichfurther includes an elongated protective bag with an upper and lowerend, and an entry port guiding fixture, said guiding fixture fittingonto said extended upper portion of said access port and containing aconically shaped inner surface for guiding said catheter into saidapparatus, said lower end of said protective bag being sealably attachedto said guiding fixture, and said upper end of said protective bag beingsealably attached to an upper end of said catheter.
 10. The respiratoryvalve apparatus of claim 9, wherein said bag is sealably attached usingadhesive tape.
 11. The respiratory valve apparatus of claim 1, whereinsaid reciprocating valve includes a hollow cylindrical sidewall with oneopen end and another closed end, said valve stem connected to said openend, said cylindrical wall having a discrete opening therein alignedwith said endotracheal tube connection port whereby a pathway is fomedthrough said open end and said opening, said closed end blocking saidresuscitation bag port is said first position.
 12. A respiratory valveapparatus of claim 11, wherein said sidewall of said reciprocating valveblocks said respirator port in said second position.
 13. A respiratoryvalve apparatus of claim 1, wherein said housing is approximatelycruciform, said resuscitation bag port and said respirator port are offset approximately 180 degrees and said reciprocating valve includes asolid disk.
 14. A respiratory valve apparatus of claim 13, wherein saidaccess port is between said resuscitation bag port and said respiratorport, said valve stem is bifurcated whereby a catheter may pass throughsaid access port and said endotracheal tube connection port while saidvalve is in said second position.